Comments and Suggestions Form

What kind of comment would you like to send? Remember this form is not for medical
matters.

Your comment is:

A SuggestionPraiseRegarding a ProblemOther

What would you like to say?

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Your contact details

Your Name:

Your Email:

Your Telephone:

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Yes, I agree that the practice may contact me regarding this matter

About This Form

Note that by using this form, you will be sending information about yourself across
the Internet. Whilst every effort is made to keep this information secure, you should
be aware that we cannot offer any guarantees of absolute privacy. If this matter
concerns you then you should use another method to notify us of your comment.

Your IP address (23.20.64.16) will be sent with
your communication. In rare cases where abuse or criminal activity can be shown
to have taken place this may be used by the authorities to trace you.